MPNforum Magazine

Richard T. Silver, the accidental hematologist

by Julie Libon

Dr. Richard T. Silver could be called the accidental hematologist.  It is through happenstance that he became not only a physician, but also an oncologist.

In Dr. Silver’s family it was not a question of whether or not you would play an  instrument but which instrument you were going to play. He went to the High School of Music and Arts. He enjoyed playing the clarinet and became so proficient that he had the honor of being first chair along with being the student director of the orchestra. Dr. Silver still plays the clarinet today. He practices three times a week and is in a chamber group.

It was Dr. Silver’s high school counselor who directed him to Cornell. He had wanted to go to MIT to be a math major. He loved his college years at Cornell. He was having the time of his life playing his clarinet in the band and from what I gathered, flirting with the girls.

It was in his third year at Cornell, as a math major, that it was suggested he interview for the medical school. He had no interest but he was curious about the process. He went dressed in a shirt and tie anyways. In his pocket he had a blue book, which was a prelim test. There were 3 men who were the interviewers. They asked what he had in his pocket and he told them it was a prelim test he had failed. The first one ever. He also told them things he didn’t like about Cornell, such as not being asked out to lunch by any faculty members. He was in this interview for about an hour, while other students waited outside the door.

When he got home for the Christmas break there was a letter of acceptance to medical school waiting for him. He thought his friends were playing a joke on him and that it was fake. He never responded to it. When he got back to Cornell, after the break, he got a call from the Dean’s office asking why he didn’t respond to the acceptance letter. Again, he thought it was fake. He got the number to the Dean’s office and called back. It was then that he realized he had been accepted to medical school without filling out an application or taking any exams. To this day, he does not know how he got into Cornell Medical College.

But clearly the admissions committee saw something. He received his AB from Cornell in 1950 and 20 years later, while a very young Associate Professor of Clinical Medicine at Cornell University Medical College, Silver authored the classic Morphology of the Blood and Marrow in Clinical Practice.

SAMSUNG

The text was good enough to warrant a foreword by the father of MPN hematology, William Dameshek, MD, who considered it a “valuable and plentiful fund of practical information.”

Dr. Silver became an intern in the ER and then a resident on the internal medicine floor of the prestigious New York Hospital.

When Dr. Silver was a second year resident there were no openings at the hospitals. He found out that the NIH needed doctors. He wanted cardiology, but there were no openings. There was, however, an opening in the cancer department, but he would have to be an intern again. After some trepidation he decided to accept the position. He found it to be very exciting because he was working with the fathers of chemotherapy. He wrote six papers and was quite the young hot shot.

In the meantime, Cornell was expanding to foreign places. Dr. Silver was the first to go. As a Fulbright scholar  he went to San Salvador, Bahia and Rio de Janeiro. It was in Rio that he met with the assistant US Ambassador  and they went to the jungles of Brazil to do blood group studies. The tribes they met with were so primitive that they — were generally naked. There were very few in the tribes, so brothers and sisters would marry to carry on the line. It was here that Dr. Silver discovered blood genes. He also found transfusion reactions related to the tribes.

As an explorer, Dr. Silver has photographed all over the world and recently won honorable mention in an international photography competition. He joined The Explorers Club after his work among the natives of the Mato Grasso of the Upper Xingu Basin in the Brazilian Amazon in 1965, where he discovered a new blood gene which has application in clinical transfusion medicine.

 Citation, The Explorer’s Club

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During this trip, Dr. Silver also served as a ship’s doctor, It was exhausting work.  He said it was a stupid thing to do and best done when you’re young.

It was at the NIH that Dr. Silver first became interested in cancer and chemotherapy.

PV and CML have always held an interest for Dr. Silver. He was looking for drugs other than hydroxyurea to use, due to the side effects. It was his idea to try interferon on PV. He found that it helped to shrink the spleen and to reduce phlebotomies.

Eventually, there were reports of using interferon for ET coming out of Europe. The results were good. There was an issue with people not wanting to take it largely due to side effects from very high initial doses. They preferred to take hydroxyurea because it was in pill form. Interferon is now the treatment of choice for many and Silver believes it can keep ET from progressing to myelofibrosis.

In the late 1990’s Dr. Silver was thinking of retiring, but along came Gleevec for CML. Novartis came to him and asked if he would be a principal investigator. Retirement would have to wait. This drug was made specifically for the genetic abnormality in CML, which is personalized medicine at it’s best.

According to Dr. Silver, PV needs constant treatment. Ruxolitinib is not a cure all like Gleevec. It does not work as well against the Jak2 gene. In PV you need to suppress activity in the disease. Interferon plus Ruxolitinib reduces the number of PV stem cells. Interferon also lowers the JAK2 burden. For patients, there can be a normal life expectancy with the use of interferon.

Dr. Silver believes that myelofibrosis should be treated early with interferon. If you allow it to progress then it is too late to treat and you will need to consider a bone marrow transplant. There are some MPN specialists who do not agree with this.

Dr. Silver is still practicing today as a leading MPN specialist, researcher and teacher. He delayed retirement when Gleevec was discovered and again with Jakafi. I do not see retirement in his future. There is still too much to do. If there are advances to be made, he will surely continue to be a part of them. Isn’t that what an Explorer does?

Last year The Silver Center for Myeloproliferative Neoplasms was dedicated at Weill-Cornell, a singular achievement for the accidental hematologist.